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General NPI Number Information
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NPI Number | 1417346867
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Entity Type | Organization
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Legal Business Name | IRC MEDICAL, LLC
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 6817 SOUTHPOINT PKWY SUITE 2304
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6282
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Country | US
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Telephone | 844-563-3633
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Fax |
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Provider Business Mailing Address
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Address Line | 13 CEDAR CT
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City | PALM COAST
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State | FL
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Zip | 32137-8953
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Country | US
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Telephone | 678-772-5506
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MARGARET L FITTON
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Credential |
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Telephone | 844-563-3633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME19409
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License Number State | FL
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